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Financial Aid Supplement

2015-2016Dear Student,

In order to assign students to certain financial aid funds, Mount Holyoke College needs to learn a little bit more about you. Kindly fill out this online form to help us determine if you fit the unique student profile these financial aid funds require, i.e., from a certain town or intending to pursue a certain career. Please note that being assigned to one of these funds does not impact the amount of financial aid you will receive.

Please complete the form below no later than August 28, 2015, in order to be considered for these funds. This is a firm deadline. Thank you very much in advance for your cooperation!

Cappie GlicaStewardship Officer

Financial Aid Supplement Form

If you are matched to one of our restricted funds, will you be willing to write a short note to the donor(s) of the fund? *

Yes

No

Personal Information

Legal First Name *

Legal Last Name *

Legal Middle Name

Email address *

(include full email address)

What year do you anticipate graduating from MHC?

What is your anticipated major? *

Note: this is not an official declaration of your major nor is this an official list of majors.

What is your anticipated minor? If your minor is not listed above, enter it below (Special or Double Major). *

Note: this is not an official declaration of your minor nor is this an official list of minors.

Special or Double Major

Permanent Home Address

Street *

City *

State *

Zip Code *

Country *

Do you have a handicap/disability?

Yes

No

If yes, please describe

Are you intending to attend graduate school?

Yes

No

If yes, what field/major (do not abbreviate)?

Are you planning a career as (check all that apply)

Doctor

Nurse

Social Worker

Missionary Work in the US

Missionary Work Abroad

Other: Medicine or Teaching (describe below)

Other - Medicine

Please describe.

Teaching

What do you plan to teach?

Education Information

What High School did you attend?

Please spell out all names, do not use abbreviations, i.e.: Holyoke H.S. should be spelled out Holyoke High School.

Name

City

State

Country

Which of one the following best describes the type of high school you attended?

Public

Independent, not religious affiliated

Independent, Catholic

Other Independent, religiously affiliated

Are you a transfer student?

Yes

No

If yes, what school did you transfer from?

Please spell out all names, do not abbreviate.

Name

City

State

Country

Family History

What is your country of citizenship?

Place of Birth

City

State

Zip Code

Country

If you are an American Citizen, do you consider yourself to be

Would you claim to be of (please answer yes or no for each category)

New England lineage?

Yes

No

Armenian descent?

Yes

No

Asian descent?

Yes

No

What is your preferred religious affiliation?

Are either of your parents teachers in a high school, junior high, middle school or elementary school?

Yes

No

Are either of your parents members of the clergy?

Yes

No

Are either of your parents officers in the Army?

Yes

No

Are 2 or more of your family members attending an institute of higher education?

Yes

No

What is the highest level of education your father completed through graduation?

What is the highest level of education your mother completed through graduation?

Were any of your parents or grandparents missionaries?

Parent:

Yes

No

Grandparent:

Yes

No

Do you have any relatives who have attended/are attending Mount Holyoke?

Yes

No

If yes, who

Tell Us More About You

Have you participated in the junior year abroad program?

Yes

No

If so, please provide information on the country, university or college attended, and area of study.

Country

City

University or College

Area of Study

If you have not participated, do you plan to in the future?

Yes

No

Year of participation or anticipated participation

Have you received any academic awards/recognition?

Yes

No

If yes, please list:

Have you/do you belong to any campus/student organizations/clubs/MHC sports teams?

Yes

No

If so, please list and note any offices held i.e., Treasurer, Editor, etc. AND the year of membership (i.e. sophomore year).